Poop watch - when will it end?

As part of the fun that comes along with the colorectal cancer ride, it is occasionally necessary to gather more direct information about your tumor(s) besides imagery from CT and PET scans. A colonoscopy or flexible sigmoidoscopy (which only views the up to the first leg of the colon) provides a direct observation to a gastroenterologist and helps assess colon and rectal health. Not to repeat myself, but having a colonoscopy done at age 50, or earlier if there is any family history of colorectal cancer, is the best way to detect pre-cancerous or cancerous polyps or tumors and have them removed or treated early. In my case this week, a flexible sigmoidoscopy was in order to assess the condition of my primary tumor. I don't want to discourage anyone from getting colonoscopies or sigmoidoscopies, but I'll be honest - it is not really a fun procedure. Actually, the procedure itself is not that bad - it's the legendary preparation the day before that is so unpleasant. With the procedure scheduled for Tuesday, that meant that Monday (Memorial Day) was prep day. The diet for prep day was "clear liquids" - juice, jello, broth, tea. This just seemed wrong for Memorial Day - sorry, no cookout on the grill, no juicy burgers. Masochist that I am, I did actually smoke a pork shoulder to make some Carolina-style pulled pork barbecue for the family unit to eat. Why would I do such a thing? 1) Practice with a new recipe; 2) I like to cook; 3) I made plenty so that when the whole procedure was over, I could have as much as I wanted for my first solid meal. It was hard to drink the beef broth and pretend it was a liquid hamburger - sorry, it's a pretty poor substitute. After "dinner" is when the fun starts. Your next task is to mix up and consume 4 liters of a vile tasting (no flavor packet can completely mask the salty taste) solution of polyethylene glycol solution (PEG) at a rate of 8oz. every 10 minutes. Pretend it's a fraternity party - if only they made ale flavor, this mental imagery might work. (Note: PEG is also used to preserve green wood and wood salvaged from sunken ships and logs!) You already know what the result is from consuming the PEG, so I won't go any further with what happens next. My question is why is this stuff only available by prescription? Who would voluntarily buy this as an over-the-counter medication? And why did I have such a difficult time finding a pharmacy that had it in stock? After dropping my prescription off at the supermarket pharmacy (complete with comments about having a "fun weekend"), I was called back over the store's public address system to find out that they had none in stock. Next stop - Walgreens. Again, a sly comment about having a "fun" weekend when I dropped off the prescription, but they did have it in stock - but it was the last one. Am I missing something? Is there some sort of traditional Memorial Day cleansing ritual I don't know about (I really don't care to know about it if there is)?

The procedure itself was easy - the gastroenterologist was great, the nurses were great. I was given the option of staying awake or being sedated - one look at the coiled up camera reminds me that as interesting as this might be, perhaps it would be better to sleep through this one. But not to fear - the doctor made prints for me so that I could see what he saw. In the interest of decorum (not a word used often here), I am not posting the pictures. If you have a burning desire to see my insides, ask and I'll send you the images. I do know what my enemy looks like now though - it's pretty ugly, red, and angry looking. I did enjoy my barbecue (Lexington-style for you Carolina barbecue scholars), although the gurgly stomach from the procedure did make it sound like I had an alien inside me (well, I do come to think of it). The gurgles come from being inflated with air during the procedure - I do have to wonder about the wisdom of inflating middle aged people, especially men, with air. Given enough time and the right diet, I think I could have done that job myself.

Is this too much information? Sorry - but it's not pretty. But it would be worse to not have this procedure available for early detection and screening. Yet many insurance companies won't pay for it if you are under age 50, unless there is compelling evidence in a request from a physician. Fortunately, legislation has been passed in a few states that allow easier access and insurance coverage for colonoscopies for those under the age of 50.

I got a new back last week. You may recall from earlier posts that I managed to injure my back. As part of my campaign to fix all the little broken things on my beat-up frame, I saw a specialist who gave me an epidural injection of steroids. I got a really nice view of the fluoroscopic image of the L4/L5 vertebrae that showed they were just slightly out of alignment (sorry, no images to share on this one). The steroids, including my favorite from chemotherapy - dexamethasone, would reduce the inflammation of the nerves and allow them some more room and not get pinched. Just another big needle, which didn't bother me until he hit the vertebrae with it - I may have bent his table. But the relief was nearly immediate. While the response was not expected for some time later, I noticed it before I left the office. I'm trying hard not to overdo it while it heals up.

Relay for Life Update!

Final Relay update before the big event - just a few days now before Relay day this Friday. I am excited about participating in the Survivor Lap at the beginning of the Relay - all the survivors wear the official purple "Survivor" shirt and it's kind of a moving sight to see the track filled with all those purple shirts. It's good to see that people do manage to survive this journey. Your generous contributions have brought my part of the campaign to nearly $4400 now and helped my team hold onto the number two fundraising team in this year's Relay. (Aside to the wags at work who said that I missed an easy joke with the "number two" reference - a little decorum please - that's twice I've used that word now.) To reach my page and make a last minute contribution on line, click here. Thank you so much for your support.

My daughter and I attended a demonstration on preparing trees for bonsai on Sunday at the Weyerhaeuser Bonsai Garden. An example of an beautiful older specimen is shown above. My daughter notices my luxuriant eyebrows (a chemo side-effect) during the demonstration and whispers "Dad - I need to prune your eyebrows", to which I reply, "Perhaps with wires, I can train them". The scissors won out of over the wires.

Poop watch

When you have colorectal cancer, a substantial part of your world involves your rear end and everything that comes out of it. It's not any kind of weird Freudian fixation, but as the primary source of your cancer and the jumping off point for possible later metastases, it really is kind of important to observe everything - it could be a sign of tumor growth or activity. Changes in size, shape, color, presence of blood in the stool can all be signs of polyps or perhaps pre-cancerous or cancerous tissue growth that are easy to ignore. If you've never had colorectal cancer this kind of attention seems kind of strange, but once you've been diagnosed and know that these observations are important and should be shared with your oncologist, it's not so weird. It's not like we observe and then score or grade our work (8.....8.5.....8.....9....and a 6 from the Russian judge.....). It's just important to be able to make an accurate observation and also be subtle and quick if in a public restroom. These are things that you would never have thought about prior to your diagnosis, and someday you hope that you won't have to think about any further.

I find myself in kind of an unusual place these days. It's like someone has reset the clock back to June 2006, with maybe a few things changed in sequence. I have the same symptoms I did when I was first diagnosed back in 2006 - difficulty and pain in my rear, pains in my abdomen and chest - signs of growing tumors. In the coming weeks, I will enjoy a "cleansing" evening after drinking a gallon of polyethylene glycol, visits to the gastroenterologist and oncologist for scans, doubt and uncertainty about the diagnosis, and optimism that whatever form of treatment I end up will kill the tumors that they will find in my rectum and liver.

Optimism is a powerful thing, and while sometimes hard to maintain, is sometimes all you have to keep you going. At the risk of getting in trouble with another joke, the subject of optimism reminds me of an old joke. There are lots of versions of it, and I've found several citations that this joke was one of Ronald Reagan's favorites. Here goes: The parents of two sons are concerned about the behavior and attitudes of their boys. One son is depressingly and hopelessly pessimistic, the other unrealistically cheerful and optimistic. They consult a family counselor who suggests some drastic therapy to shock the boys to bring them back to a more realistic outlook in life. With Christmas approaching, the counselor suggests that they fill the room of the pessimistic boy with toys, and fill the room of the optimistic boy with horse manure. On Christmas morning, the parents hear the boys stirring, and get up to see how the therapy is working. They visit the pessimistic boy's room first and find him fretting with the toys - "They might break, and the batteries will run out...". Dismayed, they check in on the optimistic boy. They look in and find him up to his chin in manure wearing a grin a mile wide. They ask him what is going on and the boy cheerfully replies, "With all this poop in here, there must be a pony in here somewhere....!". There it is - a joke about optimism that actually ties in poop. I'll keep looking for the pony.

I decided that Friday was a good day to go look for the pony. Springtime this year has been a long time in coming and Friday was an unusually warm and sunny day - after months of cloudy and cool weather, it was too difficult to concentrate on work, and frankly, I needed some time to think. I used a little vacation time and took a drive up to Mt. Rainier. The lodge at Paradise has been closed for the past two years for renovations, and Friday was the grand re-opening. I managed to get there just in time for the first lunch served in the newly re-opened restaurant. Seating was limited, so I enjoyed the company of a group of retired Park Service employees over lunch and met with the current park superintendent. I stayed at the lodge long enough to tour the grand hall, see the dignitaries and look at the cakes, and then left for a quick walk in the snow before returning home. There is still a lot of snow, almost as much as the last time I was there a few months ago, and it's the middle of May!

Relay for Life Update!

Two weeks left to go before relay weekend. Your contributions have brought my part of the campaign to nearly $3800 and helped my team to be the number two fundraising team in this year's Relay. To reach my page to contribute on line, click here. Let's keep going!

Swamp cabbage in bloom in the snow-melt fed swamps. Looking up the Nisqually River into the head of the glacier.

More cowbell...!

I'd like to report that the first few weeks with no treatment have been wonderful, but I really can't. I can say that my skin is starting to behave like normal again - no red face, no burning, no blistering/peeling, no more splitting fingers and heels - this part is good. But the problem is that I developed a fever that lasted an entire week - from last Monday until this past Monday - it would start out as a low grade fever in the afternoon, and spike to 102-103F within a few hours. It pretty much wiped my motivation to do much besides sleep. The fever is apparently linked somehow to my tumors either growing or dying or perhaps both. The title of this post is a reference to a skit that appeared on Saturday Night Live in April 2008 that spoofs the VH-1 series "Behind the Music". The skit purports to be the real recording episode of Blue Oyster Cult's hit "(Don't Fear) The Reaper" and the cowbell part in the song's introduction. The band's cowbell player (played as the fictional band member Gene Frenkle by Will Ferrel) beats the cowbell intensely, and the band protests. The producer (played in the skit by Christopher Walken) comes out of the booth and encourages them to keep the cowbell. They try the song again but stop after the cowbell overpowers the entire band. The producer comes out of the booth once more and encourages the band with this statement: "Guess what?! I got a fever, and the only prescription... is more cowbell!" . I have to give my daughter credit for this - while I was suffering through a fever spike last week, she came up to me and whispered in my ear "You need....more cowbell" - a priceless moment for me. Thankfully, the fever finally seems to have broken.

Also tied to the fever is your new phrase for the day: "referred pain". All the malevolent activity in my liver has manifested itself as severe pain in my right shoulder and neck down to my waist (this in addition to the already existing lower back pain from some still undetermined prior injury). The pain reliever of choice is the active ingredient in Alleve - naproxen sodium - it seemed to work, and is a staple in my box 'o drugs.

I remain optimistic that alternate treatment will be the magic bullet that moves me past this present state. As I said in my last post, I'm kind of creeped out knowing that the critters are growing as I write this. I don't expect that they'll burst from my chest like the baby aliens in the movie "Alien", but I know the signs now that I didn't know when I was first diagnosed.
Pains in the chest and back, trouble in the bathroom (I won't elaborate), etc - all were signs before that I attributed to other problems, but turned out to be symptoms that I didn't catch the first time around. I'm not seeing these problems yet, but I can't help but be mindful of every pain, every unusual bowel movement and wondering if this is happening all over again.

To those readers who are subscribers and have this blog sent to their email, I apologize for the unusual behavior. You recently received an old posting in your email about getting screened (Oct. 21, 2007 post) - I didn't send it, although it did seem timely. I'm not sure what happened, although it did occur while I was editing my last real posting to correct an error after it was published. Let's see what happens this week....

Relay for Life Update!
I don't know what to say - at this point, I am nearly $1700 over my original goal and nearly $2000 above what I raised last year. Our relay is May 30-31, so we still have a few weeks to go. Let's keep going! To reach my page to contribute on line, click here. If you'd like, my daughter is also walking - if you want to spread the donations out (it all goes to the same place - our friends at the American Cancer Society), you can reach her Relay page by clicking here.